SPT-Fall2014

esponse. Because there is evidence
of a destabilization of the vago-vagal
feedback loop in bulimics (Faris,
2006, 2009), relapse is common and
beyond the locus of control of the
sufferer once the binge-purge cycle
becomes ‘hard-wired’. This requires a
titration of the nutritional reeducation
phase within the client’s
window of tolerance to try feared
foods and tolerate fullness.
In my experience, my bulimic
patients have the highest states of
hyper-arousal and require significant
assistance to develop somatic
grounding, orienting, and settling
skills before they can be helped to
discharge the activation they
experience, which is usually expelled
through excessive exercise, vomiting
or laxatives until other skills are
developed.
A 22-year-old was continuing to
have intense urges to purge and selfharm
through cutting after almost one
year in residential treatment and was
afraid to leave treatment. She was
frightened to address the childhood
sexual abuse trauma that led to her
symptoms. Learning that she could
process her trauma response
somatically, without verbally having
to tell the story, increased her
willingness to see me. I asked her to
“walk-and-talk” outdoors in order to
increase orientation to safety in the
here-and-now and movement to
decrease the sense of immobilization
by fear. While walking, I asked her
whether the trauma memories
consisted of thoughts, sensations, or
images. She replied images, stating
that one predominant image caused
her the highest distress. She was
instructed to “freeze” the image and
place it at a distance of her choice,
granting her the power that she
lacked during the initial event. This
allowed her to begin to tap into the
body sensations associated with the
experience and safely discharge them,
while also helping her differentiate
(or uncouple) the stress of lifethreatening
fear from the stress of a
final exam; this allowed her to
tolerate returning to school. Next, we
addressed the impulses to self-injure,
which she described as serving a
function to orient to the source of the
threat (“at least I know where the
pain is”), as well as to provide
numbing, which she described as
“floating in a pool of warm water.”
She was “prescribed” to float in her
pool daily with mindfulness to
experience the soothing effects.
Finally, she was asked to use
expressive art to “yell” the “NO!” she
was unable to voice. Together, these
and other sensorimotor interventions
allowed her to quickly feel that she
could ‘move on’, discharge from
treatment, and return to college.
Case Study: Binge Eating Disorder
Overweight/obese compulsive
overeaters and binge eaters, on the
other hand, display similar shutdown
or disconnection from internal states
as anorexics. Anorexics become
significantly aroused by the feeling of
food in the stomach, while overeaters
are triggered by the sense of
emptiness and hunger – even if at a
more subconscious or autonomic
body level. These groups require help
in increasing awareness of arousal
states through skills in tracking
bodily sensations mindfully so these
arousal states can be safely
discharged and not induce either
starving/dieting or overeating
behaviors.
A 56-year-old widowed woman
with a long history of binge eating
and struggles with weight
management described her
experience as one of core emptiness
and desperate loneliness. Her longing
for connection and to “fill the void”
led her to nightly binges that filled
her up physically (which she
recognized only when extremely full)
but not emotionally. Every episode
increased her despair. Additionally,
she described feeling invisible to the
world around her when she was
growing up and needing to generate
greater body mass and “take up a
bigger space” in order to “be seen.”
Sadly, because of social discomfort
with largeness, she had become a
target of bullying to those who would
shame her for her size and of greater
invisibility to those who would just
look away to avoid their discomfort.
Gradually, through mindfulness
training to increase interoception, and
body movements to engage a sense of
core strength and embodiment, she
began to notice and become aware of
the fact that “the emptiness is not so
empty.” Her ‘authentic self’ began to
fill her, and she felt less need to binge
and greater satiety when eating foods
that pleased her.
Summary
The use of mindfulness and somatic
practices that increase body
awareness, assist in the regulation of
autonomic hyper-arousal or hypoarousal,
and discharge the ‘undigested’
survival energies of trauma,
is quickly gaining relevance in the
treatment of eating disorders. Yoga,
the expressive arts and psychodrama,
movement and dance therapies, and
integrative mind-body
psychotherapies such as Somatic
Experiencing® (Levine, 1997, 2010)
are increasingly available at treatment
centers. These approaches increase
interoceptive and proprioceptive
awareness through the use of sensorymotor
tracking skills that strengthen
the insula, the anterior cingulate
gyrus, and the connections between
Somatic Psychotherapy Today | Fall 2014 | Volume 4 Number 2 | page 62